1. Field of the Invention
This invention relates to use of a preparation for therapeutically treating renal disease such as nephrotic syndrome (nephrosis), particularly glomerular nephrosis, the preparation containing N-acetylneuraminic acid (NANA) or its salt as an effective ingredient.
2. Description of the Prior Art
N-acetylneuraminic acid (NANA), which is a sialic acid, has been reported in the following articles [1] to [4] to exhibit anti vital action, anti inflammatory action and anti allergic action, as the case may be:
[1] Hirsch, R. L. et al, The Journal of Immunology 1981, 127 (No. 5):1740-1743 (anti vital action),
[2] Gorog, P. et al, Agents and Actions 1978, 8 (No. 5):543-545 (anti inflammatory effect),
[3] Itoh, H. et al, Yakuri to Chiryo (Japanese) 1985, 13 (No. 7):479-494 (anti inflammatory action),
[4] Murata, Y. et al, The 61st General Conference of Japan Pharmacology Society, March 23-26, 1988, Anti-allergic action of N-acetylneuraminic acid (NANA) in guinea pigs (Japanese), 0-276 English abstract.
The inducing mechanism of puromycin aminonucleoside (PAN) on nephrosis, i.e. nephrotic syndrome, is discussed in the following articles [5] to [10] regarding PAN induced nephrotic syndrome modeling studies:
[5] Messina, A. et al, Am J Pathol 1987, 126:220-229,
[6] Kerjaschki, D. et al, Am J Pathol 1985, 118:343-349,
[7] Kasinath, B. S. et al, Am J Pathol 1988, 225:F590-F596,
[8] Olson, J. L. et al, Lab Invest 1981, 44 (No. 3):271-279,
[9] Baricos, W. H. et al, Biochem J 1986, 239:705-710,
[10] Diamond, J. R. et al, Am J Pathol 1990, 137 (No. 6):1323.
These articles [5] to [10] make clear that nephrosis (nephritis) as induced by PAN is commonly referred to as nephrotic syndrome, and that such is regarded as comparable to nephrotic syndrome as actually occurs in human patients.
It is noted that Stedman's Medical Dictionary, 24th ed 1982, defines "nephritis" (p. 932) as "Inflammation of the kidneys" and "nephrosis" (p. 934) as "1. Nephropathy. 2. Degeneration of renal tubular epithelium. 3. Nephrotic syndrome" whereas "lipoid n[ephrosis]" is defined (p. 932) as "membranous glomerulonephritis." This interchangeability of "nephrosis" and "nephritis" as used in "lipid nephrosis" and its equivalent "membranous glomerulonephritis," is also observed in referring to PAN induced nephritis and PAN induced nephrosis as contemplating nephrotic syndrome.
5] Messina, A. et al points to glomerular epithelial abnormalities as the mechanism of PAN induced nephrosis (nephrotic syndrome) which causes proteinuria (albuminuria). It refers to PAN induced proteinuria in aminonucleoside nephrosis experimental modeling and its applicability to human glomerular disease, particularly in minimal change disease (lipoid nephrosis, i.e. membrane glomerulonephritis), due to its many common features with minimal change disease. Its findings on rats indicate that in PAN nephrosis, proteinuria results from glomerular epithelial injury, leading to formation of focal gaps in the epithelial covering of the glomerular basement membrane (GBM), where increased water flux causes plasma proteins to be dragged across the GBM filter to the urinary space.
Because such focal areas of externally denuded GBM have been observed in the glomeruli of nephrotic (human) patients with various types of glomerulonephritis, including focal glomerulosclerosis and hyalinosis, amyloidosis, minimal change disease, membranous glomerulonephritis (lipid nephrosis), diabetic glomerulopathy, and lupus nephritis, it is considered that formation of these bare areas of GBM also play a role in the pathogenesis of proteinuria in these (human) glomerular diseases.
This article exemplifies the equivalency or interchangeability of nephrosis and nephritis as regards nephrotic patients with various types of glomerulonephritis, and the applicability of animal (rat) test results as indicative of comparable results in human patients suffering from renal disease.
[6] Kerjaschki, D. et al shows that loss of polyanion, which is present on glomerular epithelial cells (GEC), occurs in PAN nephrosis. It notes that minimum change nephrosis is a disease that can be induced experimentally in rats by PAN, and that proteinuria is the pathophysiologic hallmark of minimum change nephrosis both in PAN rats and in humans. It indicates that rat renal GEC (podocytes) contain glomerular epithelial polyanion which is lost in minimum change nephrosis, e.g. as induced in rats by PAN.
This article exemplifies the identity of proteinuria as associated with both animal (rat) and human minimum change nephrosis.
[7] Kasinath, B. S. et al shows that PAN reduces heparan sulfate proteoglycan (HSPG) in rat GEC. It notes the in vivo and in vitro toxicity of PAN to rat GEC in regard to PAN induced nephrosis.
[8] Olson, J. L. et al demonstrates that both glomerular size and charge barriers of GBM are impaired in PAN nephrosis. It notes that aminonucleoside nephrosis (proteinuria and renal damage) is an experimental model of nephrosis induced as a disease in rats by administering PAN, resulting in renal damage including GEC injury. It also notes that the mechanism of proteinuria in this model of nephrosis (nephrotic rats) has been frequently investigated, and that the aminonucleoside nephrosis induced in the rats provides a model comparable to the minimal change nephrotic syndrome in human patients.
This article similarly exemplifies the applicability of animal (rat) test results as indicative of comparable results in human patients suffering from renal disease.
[9] Baricos, W. H. et al indicates that normal glomeruli contain relatively high activity of neuraminidase, which activity is not changed by onset of proteinuria associated with PAN induced nephrotic syndrome. It refers to experimentally induced nephrotic syndrome in rats by PAN as a well documented model of glomerular disease, and compares human and experimental glomerular diseases interchangeably and also compares PAN models of glomerular nephritis and nephrotic syndrome interchangeably.
This article similarly exemplifies the equivalency or interchangeability of nephrosis and nephritis as regards glomerular nephritis and nephrotic syndrome, and the applicability of animal (rat) test results as indicative of comparable results in human patients suffering from renal disease.
[10] Diamond, J. R. et al refers to the role of dosage schedule and administration route of PAN in the progress of thereby induced proteinuria, noting that aminonucleoside nephrosis, i.e. in rats per PAN induced proteinuria, is an experimental model of nephrotic syndrome which, depending on the dosage and administration route, progresses to focal and segmented glomerulosclerosis (FSGS).
In essence, articles [5] to [10] collectively show that PAN induced nephrotic syndrome (PAN nephrosis, PAN nephritis) and associated proteinuria represent an experimental model in lower mammals (rats, guinea pigs, etc.) of glomerular disease (abnormality) in higher mammals (human beings), i.e. glomerular nephritis (and its equivalents: minimum change nephrotic syndrome, lipoid nephrosis, membranous glomerulonephritis, glomerular nephrosis, etc.), with the test results of therapeutic treatment of lower mammals being indicative of comparable results in human patients suffering from renal disease.
The following patents [11] to [20] relate to methods of treating renal disease:
[11] U.S. Pat. No. 3,896,228, issued Jul. 22, 1975 to Richardson, concerns treating nephrosis, i.e. nephropathies or chronic nephritis, by administering to an animal in need of such treatment a therapeutically effective amount of a prolactin inhibitor such as ergocornine, which thereby increases urine volume and pH (or urine electrolyte values, particularly sodium and potassium values). Tests on animals (rats) which normally suffer from nephrosis or a deposition of urine proteins (albumins and globulines) in kidney tubules indicate that such deposition is lowered following treatment, which is attributed to increased solubility of the urine proteins following prolactin inhibitor administration. The treatment can be used for conditions where protein deposits or casts already exist in the kidney tubules such as nephrosis or renal failure, especially chronic renal failure, whereby degenerative progression of renal failure may be inhibited in its early stages before complete blockage of kidney tubules occurs following urine protein deposition.
The prolactin inhibitor may be formulated with a carrier such as ascorbic acid, acetic acid, ethanol and water for solutions, and talc, lactose, maize starch, polyvinyl pyrrolidone and magnesium stearate for solid forms, and administered at a daily dose of about 0.01-3.0 mg/kg of animal body weight, or for larger mammals at a daily dose of about 0.5-15 mg. Parenteral unit dosage forms may contain about 1 mg of the inhibitor, and oral unit dosage forms may contain about 3 mg, or for larger mammals about 750-3000 mg.
This patent recognizes the equivalency or interchangeability of nephrosis and nephritis as regards chronic renal failure.
[12] U.S. Pat. No. 4,122,189, issued Oct. 24, 1978 to Kurosawa et al, concerns treating a human exhibiting a disorder of excessive urinary protein and/or of secondary hyper lipoidemia due to renal disease by internally administering to the human a known methyl methionine sulfonium salt in an amount effective to produce anti-excessive urinary protein therapy and/or anti-hyper lipoidemia therapy during the course of renal disease. It is noted that in therapy for renal diseases, certain agents have been used as medicines for nephrotic syndrome, and accordingly said sulfonium salt also serves as a medicine for renal disease nephrotic syndrome which is characterized by excessive urinary protein. The sulfonium salt is effective for excessive urinary protein, hypercholesterolemia, as clinical tests on patients suffering from excessive urinary protein (e.g. due to nephritis, nephrotic syndrome, etc.) indicate elimination or reduction of urine protein consequent said salt treatment.
Aminonucleoside nephrosis therapy tests on rats, in which aminonucleoside (AN) was used to induce renal disease, followed by treatment with the sulfonium salt, produced analogous results to those obtained in said clinical tests on patients. Hetero anti kidney serum (rabbit) nephritis therapy on rats, in which anti kidney serum was used to induce renal disease, followed by treatment with the sulfonium salt, also produced analogous results.
The sulfonium salt may be administered at a daily dosage of more than 200 mg, usually 1000-2000 mg in an oral dose form for adults, or in other medical forms.
This patent recognizes the equivalency or interchangeability of nephrosis and nephritis as regards nephrotic syndrome and nephritis renal disease, and establishes that induced renal disease test results on animals such as rats are indicative of comparable results in human patients suffering from renal disease.
[13] U.S. Pat. No. 4,178,285, issued Dec. 11, 1979, and its division [14] U.S. Pat. No. 4,264,589, issued Apr. 28, 1981, to Felts et al, commonly show the separating of the active alpha.sub.1 acid glycoprotein (alpha.sub.1 -AG) fraction, a co-factor in the lipoprotein lipase reaction, from nephrotic animal and human urine, for use in replacement therapy in an effective amount in nephrotic animals (rats) to reverse the defect in triglyceride (TG) removal caused by loss of plasma constituents in urine, i.e. to reduce the increased amount of TG in the blood. Rats with PAN induced nephrotic syndrome showed a decrease in TG (lipid) clearance, which was restored to normal by injection of said AG fraction, suggesting that elevated plasma TG in human nephrotic patients is the direct result of excessive loss of said AG fraction and/or associated components from plasma into urine and that human patients are amenable to replacement therapy.
As to nephrotic syndrome or kidney disease, it is stated that a severe excess of lipids in the blood is a common disorder in patients or experimental animals with kidney disease characterized by excess of protein in urine (proteinuria) and reduced protein in blood (hypoproteinemia), the elevated excess of TG in the blood being considered to result from a slower clearance of chylomicrons and very low density lipoproteins (VLDL) from the circulation, and/or increased VLDL synthesis by the liver. It is postulated that urinary loss of apolipoproteins and other co-factors necessary for TG clearance by the lipoprotein lipase (LPL) enzyme system is responsible for a defective clearance of chylomicrons and VLDL.
Per the teaching of these patents, an LPL co-factor in urine was identified which is similar or identical to plasma alpha.sub.1 -AG and/or an associated component, and which in experimental nephrotic rats with a TG removal defect, can restore the TG metabolism rate to normal. This confirms that experimental nephrosis is induced in rats by administering PAN, whereby they display the common disorders of human nephrotic syndrome: proteinuria, hypoproteinemia and hypertriglyceridemia, the nephrotic rats specifically displaying a reduced rate of TG clearance which was reversed on administering said AG fraction such that TG clearance increased to the normal rate.
These patents similarly establish that induced renal disease test results in animals such as rats are indicative of comparable results in human patients suffering from renal disease.
[15] U.S. Pat. No. 4,339,442, issued Jul. 13, 1982 to Takemoto et al, concerns treating adrenal atrophy by administering to a host afflicted therewith a therapeutically effective amount of a stated gynosaponin, which is indicated to act on the cells of animals, including man. Clinical tests on a human patient having as a disease: chronic nephrosis type nephritis, and a moon face caused by glucocorticoid (steroid) administration, showed the effectiveness of treatment with said gynosaponin together with the glucocorticoid in improving kidney function (cols. 26-27).
The gynosaponin may be formulated with a solid or liquid excipient or carrier, e.g. as an internal (oral) preparation including lactose, starch, dextrin, calcium phosphate, calcium carbonate, etc., at a daily dosage in man (human being) of about 50-1000 mg.
This patent similarly recognizes the equivalency or interchangeability of nephrosis and nephritis as regards chronic nephrosis type nephritis.
[16] U.S. Pat. No. 4,442,093, issued Apr. 10, 1984 to Maeda et al, concerns treating hyper phosphatemia due to reduction of excreting function (increased resorption) in the kidneys in the morbid state such as that of chronic renal failure, hypo parathyroidism, acromegaly and acute dis-used bone atrophy by administering to a human or an animal suffering therefrom a therapeutically effective amount of a stated hydroxy cholecalciferol compound. Administering said compound to rats in a state of hyper phosphatemia due to nephrectomy (resulting in one third of a kidney remaining), as well as to rats pretreated with PAN (AN) to bring them to a stage of hyper phosphatemia, in each case caused reduction of the serum inorganic phosphate level of the rats. Administering said compound to a human patient having chronic renal failure showing a symptom of hyper phosphatemia, similarly caused reduction of the serum inorganic phosphate level of the patient to normal.
Said compound may be formulated with ethyl alcohol, isopropyl alcohol, ethylene glycol, propylene glycol solution, oil solution, aqueous suspension, etc. Triglyceride esters of fatty acids such as capric and caproic acids, corn oil, etc. may be used as solvent for the oil solution. Other formulation components include lactose, magnesium stearate, sorbic acid, sorbate salts, saccharides or their alcoholic derivatives, physiological saline solution, surfactants, anti oxidants, etc. The daily dose of said compound to an adult patient of 50-60 kg average body weight is about 1.times.10.sup.-2 to 1.times.10.sup.5 (0.001-100,000) micrograms (cols. 8-9).
This patent confirms that induced renal disease test results in animals such as rats are indicative of comparable results in human patients suffering from renal disease (cf. col. 5).
[17] U.S. Pat. No. 4,820,689, issued Apr. 1, 1989, and its division [18] U.S. Pat. No. 5,008,243, issued Apr. 16, 1991, to Ikuzawa et al, commonly concern treating nephrotic syndrome such as ameliorating proteinuria and proteinemia, by administering to a human suffering therefrom a therapeutically effective amount of a known stated glycoprotein compound. Tests of administering said compound to rats made to show nephrosis-like symptoms by administration of AN (aminonucleoside), which is known to cause proteinuria, and to a human patient having lupus nephritis as well as to a human patient having diabetic nephropathy, showed analogous effects for repressing proteinuria due to AN, or ameliorating lupus nephrosis or diabetic nephropathy (FIGS. 5-7; cols. 7 and 19-20).
Said compound may be formulated with conventional additives for oral or parenteral administration to human patients in a daily dosage of about 10-1000 mg/kg of body weight such as 3 g/day (cols. 10 and 20).
These patents similarly recognize the equivalency or interchangeability of nephrosis and nephritis as regards nephrotic syndrome and lupus nephritis as well as lupus nephrosis, and confirm that induced renal disease test results in animals such as rats are indicative of comparable results in human patients suffering from renal disease.
[19] U.S. Pat. No. 4, 912,215, issued Mar. 27, 1990 to Yazawa et al, concerns production of a stated Q-1047 substance useful as a therapeutic agent for nephritis. Tests on PAN nephrosis rats using the Q-1047 substance show that while the PAN induced nephrosis rats had an increase in urinary protein level, those then given the Q-1047 substance did not, with consequent kidney tissue examination indicating that the rats given PAN alone showed degeneration and necrosis of glomerular capillary vessels, hypertrophy of endothelial cells, mesangial thickening due to hyperplasia of mesangial cells and deposition of hyaline droplet-like substance, whereas in rats also given the Q-1047 substance such changes or abnormalities were lesser in extent and lower in incidence (FIG. 35; cols. 9-10).
The Q-1047 substance may be formulated with excipients such as lactose, starch, etc. for oral administration, and with preservatives for non-oral administration, at an oral dose of about 0.1-100 mg/kg of body weight about 1-3 times daily, or in the form of an injection at a dose of 0.1-10 mg/kg.
This patent similarly recognizes the equivalency or interchangeability (per se) of nephrosis and nephritis, and confirms that induced renal disease test results in animals such as rats are indicative of comparable results in human patients suffering from renal disease.
[20] U.S. Pat. No. 5,182,266, issued Jan. 26, 1993 to Kleinert, concerns treating or inhibiting renal dysfunction (disease) such as chronic or acute renal failure in a human (or other mammal) by administering to the human a therapeutically effective amount of a known stated amino acid amide compound serving as renin inhibitor. It is stated that renal diseases are characterized by reduced renal blood flow, reduced glomerular filtration rate (GFR), proteinuria, hematuria and/or alterations in water and sodium excretion. It is also stated that the effect of a renin inhibitor on renal failure can be demonstrated by observing the effects on renal hemodynamics that can alter GFR of a renin inhibitor administered to animals in which acute renal failure has been modeled, for example ischemia, ureteral obstruction or nephrotoxic agents such as gentamicin, cis-platin and the like; and also that the effects of a renin inhibitor on chronic renal failure can be demonstrated by observing the effects on proteinuria, histopathologic improvement and long term stabilization of GFR of a renin inhibitor administered to animals in which chronic renal failure has been modeled, for example by reduced renal mass, puromycin-induced nephrosis or diabetic nephropathy (col. 45).
This patent sets forth the following background information (cols. 1-2).
Acute renal failure is noted as a condition characterized by an abrupt and sustained reduction in GFR occurring within a period of hours in response to an acute ischemic or nephrotoxic insult, which is not immediately reversible when the initial disturbance has been eliminated. Immediate improvement in GFR and increasing fluid flow through the nephron appears to be of critical importance in the prognosis of acute renal failure.
Chronic renal failure is noted as being characterized by (1) a reduction in GFR that has been evident for 3 to 6 months, (2) a continued decline in GFR over a period of years and (3) symptoms of uremia. The term renal insufficiency is often used to characterize a condition in which a mild reduction in GFR has occurred, but no uremic symptoms have appeared. Chronic renal failure denotes irreversible nephron loss, whereas acute renal failure reflects a reduction in single nephron GFR due to potentially reversible nephron injury.
It is noted that proteinuria (elevated urinary excretion of plasma proteins) can be present during acute and chronic renal failure and has been shown to be an accurate index of the extent of glomerular damage. Agents that reduce proteinuria have been shown to have beneficial effects on glomerular injury.
It is also noted that angiotensin II (A II) is believed to play a role in renal failure, A II being a peptide hormone produced in the kidney in a two step process, the first step of which is the cleavage of angiotensinogen by the enzyme renin. Renin is stored primarily in the juxtaglomerular cells of the kidney. It is further noted that A II has profound effects on the kidney, including direct vasoconstriction of the renal vascular bed thereby altering renal blood flow, stimulation of sodium resorption, modification of glomerular feedback, alteration of GFR through changes either in the hydraulic pressure or by reducing the filtration surface area secondary to mesangial cell contraction, and increasing distal nephron sodium resorption indirectly through stimulation of aldosterone secretion. A II increases the passage of circulation macromolecules into the glomerular mesangium and decreases their egress. All these effects of A II have a negative impact on renal disease, whereby an agent that prevents or inhibits formation of A II, such as a renin inhibitor, can have a beneficial effect on renal disease.
The renin inhibitor may be formulated with vehicles and solvents such as water, dextrose solution, mannitol solution, Ringer's solution and isotonic chloride solution, or solids such as sucrose, lactose or starch at a daily dosage of about 0.001-10 mg/kg of body weight (cols. 45-46).
This patent confirms that induced nephrosis modeling results are indicative of comparable results in human patients suffering from renal disease.
The following patents and publications [21] to [28] relate to use of N-acetylneuraminic acid (NANA):
[21] U.S. Pat. No. 4,410,515, issued Oct. 18, 1983 to Horlick et al; [22] U.S. Pat. No. 4,521,410, issued Jun. 4, 1985 to Horlick et al; and [23] U.S. Pat. No. 4,661,294, issued Apr. 28, 1987 to Horlick et al; commonly concern methods of treating calcium and phosphorus metabolic disorders in an animal, especially humans, i.e. in a mammal, by administering thereto in an amount sufficient to regulate calcium and phosphorous homeostasis therein of a stated water soluble vitamin D type compound including a glycosidic residue therein such as an N-acetylneuraminic acid (NANA) residue. Tests on rats and on human fibroblasts with said compound confirm the efficacy of the treatment methods.
[24] U.S. Pat. No. 4,698,332, issued Oct. 6, 1987 to Ogasawara et al (of common assignee herewith) concerns promoting expectoration by administering to a human being by inhalation, an effective amount of NANA or a pharmaceutically active salt thereof, which as an expectorant acts on the theological properties of sputum and directly promotes ciliary motion in the airway for removing the sputum. Tests using cilium cells from the human airway and cilia of frog palatine mucosa before and after application of NANA or its salt confirm the efficacy of the method as sufficient for treating human patients.
[25] U.S. Pat. No. 5,177,062, issued Jan. 5, 1993 to Miyata et al (of overlapping inventorship and common assignee herewith) concerns treating immune complex (antigen-antibody complex) diseases characterized by an Arthus type inflammatory response in an animal, by administering to the animal, e.g. by injection, a preparation having an effective amount of NANA or a salt thereof. It is stated that the Arthus reaction is an inflammation reaction which can be observed on the skin as edema and bleeding. Tests are set forth using NANA or its salts on guinea pigs for passive cutaneous Anaphylaxis reaction for determining inhibition of type I allergy; for determining inhibition of histamine increase due to bronchial anaphylaxis; and for Passive Arthus reaction for determining inhibition of skin bleeding; and on rats for determining inhibition of leukotriene level increase due to sulfate gas exposure.
[26] European Pat. Application No. 296,620 (EP-A 296,620), published Dec. 28, 1988, which is analogous to said [24] U.S. Pat. No. 4,698,332, concerns treating a human or animal living body by spraying the nostrils with NANA or a salt thereof for relieving nasal obstruction symptoms of a mucous membrane, with tests on rats and on human fibroblasts using NANA or its salt confirming the efficacy of the method as sufficient for treating human patients.
[27] European Pat. Application No. 386,657 (EP-A 386,657), published Sep. 12, 1990, generally corresponds to said [25] U.S. Pat. No. 5,177,062.
[28] Japanese Pat. Application Publication No. JP 1,299,294 (JP-A 1,299,294), published Dec. 4, 1989 (English abstract), concerns use of NANA as a starting material in a process for producing an anhydro derivative thereof serving as a new anti vital, anti nephritic and anti dement agent.
The inventors have found an inhibitory effect of N-acetylneuraminic acid on renal disease such as nephrosis, i.e. nephrotic syndrome, and particularly glomerular nephrosis, which action had not been known, leading to the present invention.
The anti vital, anti inflammatory and anti allergic actions of N-acetylneuraminic acid noted in said articles [1] to [4], and its expectoration promoting, immune complex disease inflammatory response, and nasal obstruction relieving, actions noted in said patents [24] and [25] and publication [26], are completely unrelated to its therapeutic effectiveness according to the invention on nephrosis in the field of renal disease as contemplated in said articles [5] to [10] and patents [11] to [20].